In this section
Measurement of intra-abdominal pressure is used to identify children at risk of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). IAH & ACS are most likely to occur in the setting of major fluid resuscitation, severe gut oedema, intra-peritoneal or retroperitoneal bleeding, or ascites. Patient groups may include trauma, burns, septic shock, post abdominal surgery. IAH & ACS can cause significant morbidity and mortality due to reduced venous return and cardiac output, and altered respiratory mechanics. This results in end organ dysfunction; renal failure, impaired hepatic blood flow, respiratory failure, poor splanchnic perfusion and increased intracranial pressure are potential problems. Early recognition and treatment of IAH & ACS has been shown to significantly improve morbidity and mortality.
The aim of this guideline is to outline the management principles related to intra-abdominal pressure monitoring within the Paediatric Intensive Care Unit at the Royal Children's Hospital.
Bladder Pressure: reflects the intra-abdominal pressure and is measured via the indwelling urinary catheter. It is expressed in mmHg.
Intra-abdominal Pressure (IAP): is the pressure within the abdominal cavity.
Intra-abdominal hypertension (IAH): is defined as a sustained or repeated pathological elevation of IAP greater than 10 mmHg.11
Abdominal compartment syndrome (ACS): is defined as sustained IAP greater than 10 mmHg, with or without abdominal perfusion pressure less than 60mmHg13 and the onset of new or worsening organ failure directly attributed to elevated IAP. The syndrome is associated with 90%-100% mortality if not recognised and treated in a timely manner. 11
Abdominal perfusion pressure (APP): APP = Mean Arterial Pressure (MAP) – IAP. In adults keeping this greater than 50-60mmHg significantly improves morbidity & mortality. The appropriate APP for children is unknown, but will be less than the adult level due to a lower MAP.
Primary IAH or ACS: is a condition associated with injury or disease in the abdominopelvic region that frequently requires early surgical or interventional radiological intervention
Secondary IAH or ACS: refers to conditions that do not originate from the abdominopelvic region
IAP can be measured directly or indirectly.
Infection of the bladder is a complication of this procedure. Symptoms vary depending on the age of the child but include:
Urine culture and sensitivity is the gold standard for diagnosis if an infection is suspected
World Society of Abdominal Compartment Syndrome: http://www.wsacs.org/
Click here to view the evidence table for this guideline.
1. Balough Z, Jones B, Amours S, Parr M and Sugrue M (2004) Continuous intra-abdominal pressure measurement technique. The American Journal of Surgery Volume 188(6):679-6842. Cheatham M, Malbrain M, Kirkpatric A, Sugrue M, Parr M et al (2007). Results from the international conference of experts on intr-aabdominal hypertension and abdominal compartment syndrome. II Recommendations. Intensive Care Medicine. 33:951-962.3. Davis P, Koottayi S, Taylor A, Butt W. (2005) Comparison of indirect methods of measuring intra-abdominal pressure in children. Intensive Care Medicine. 31:471-4754. Ejike J, Bahjri K, Mathur M. (2008). What is the normal intra-abdominal pressure in critically ill children and how should we measure it? Critical Care Medicine. 36(7):2157-21625. Ejike J, Kadry J, Bahjri K, Mathur M. (2010). Semi recumbent position and body mass percentiles: effects on intra-abdominal pressure measurements in critically ill children.6. Gallagher JJ (2000) Ask the Experts Critical Care Nurse, 20, 1 p: 87. 7. Iberti TJ, Lieber CE, Benjamin E. (1989) Determination on intra-abdominal pressure using a transurethral bladder catheter: clinical validation of the technique. Anesthesiology, 70 (1): 47-50 8. Kirkpatrick A, Roberts D, Waele J, Jaeschke R, Malbrain M, et al (2013). Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Medicine 39:1190-12069. LCP Rao, CR Chaudhry, LCS Kumar (2006) Abdominal Compartment Pressure Monitoring - a simple techniques. MJAFI,Vol. 62, No. 3.10. Newccombe, J., Mathur, M. & Ejike, J.(2012) Abdominal Compartment Syndrome in Children. American Association of Critical-Care Nurses, Dec; Vol. 32 (6), pp. 51-61; Publisher: 11. Ravishankar N, Hunter J (2005) Measurement of Intra-abdominal hypertension in intensive care units in the United Kingdom. British Journal of Anaesthesia Volume 94, Number 6 Pp. 763-766.12. Reitsma J, Schumacher B (2018) Nursing Assessment of intra-abdominal hypertension and abdominal compartment syndrome in the neonate. The National Association of Neonatal Nurses; Vol 18 (1): 7-13 13. Stafford, R. (2004, Revised 2008) Intra-Abdominal pressure monitoring. Publisher: Operative Techniques in General Surgery. http://www.surgicalcriticalcare.net/Guidelines/intraabdominal_pressure_monitoring.pdf14. Prasad G R, Subba Rao J V, Aziz A, Rashmi T M (2012) The role of routine measurement of intra-abdominal pressure in preventing abdominal compartment syndrome. J Indian Association of Paediatric Surgeons; Vol 22 (3):134-13815. Woolford, M. Skylas, K. (2014) Intra-abdominal Pressure Monitoring (IAP), CRG_PG2014_9088; Sydney Local health District https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0016/334150/crg_pg2014_9088.pdf
Please remember to read the disclaimer.
revision of this nursing guideline was coordinated by Jenny Raccanello and Kim Morris of PICU,
and approved by the Nursing Clinical Effectiveness Committee. Updated January 2020.